Pediatric Coding Alert

Question: Through negotiations, some payers have agreed to cover non-face-to-face services at our clinic. What can we count toward this time?

Michigan Subscriber

Answer: For prolonged physician service without direct patient contact, you may count time that the physician spends on the E/M service above and beyond what the pre-, intra- and postservice include. The preservice work includes necessary prep work, such as pulling and reviewing the patient's chart. Completing the chart work is an example of postservice work.

You need 30-75 minutes of documented non-face-to-face care to report +99358 (Prolonged E/M service before and/or after direct [face-to-face] patient care [e.g., review of extensive records and tests, communication with other professionals and/or the patient/family]; first hour [list separately in addition to code[s] for other physician service[s] and/or inpatient or outpatient E/M service).

For each additional 30 minutes beyond the first 75 minutes, you can code one unit of +99359 (... each additional 30 minutes [list separately in addition to code for prolonged physician service]). Some examples of non-face-to-face prolonged physician service before and/or after direct patient care include:

• review of extensive records and tests

• communication with other professionals and/or the patient/family including phone time.

Example: An office pediatrician is going to see an infant who has graduated from the premie nursery for the patient's first encounter with the group. The child comes with apnea monitor and feeding tube and is on home oxygen. Before seeing the child, the pediatrician spends extensive non-face-to-face time reviewing the patient's records. The physician bills a high-level new patient visit (99205) and then spends time coordinating care with community resources and with home nursing services.

Total non-continuous, non-face-to-face documented time for the date of service is 100 minutes. You add 99358 and 99359 to the 99205 claim.